External Counterpulsation (EECP/ECP) Therapy is included in the latest Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017. The article is published in the latest Stroke and Vascular Neurology, the official journal of the Chinese Stroke Association.

As pointed out in the abstract, the authors state that collateral circulation plays a vital role in sustaining blood flow to the ischaemic areas in acute, subacute or chronic phases after an ischaemic stroke or transient ischaemic attack. It therefore makes sense that External counterpulsation (ECP), which improves collateral circulation throughput the cardiovascular system would be an effective method for improving blood flow to the brain post stroke.

As further stated in the publication “ECP is a non-invasive method that enhances cardiac output and blood flow to vital organs including the brain, by inflating pressure cuffs around the lower extremities and the buttocks during the diastole and deflating the cuffs during the systole. ECP treatment is safe and feasible in patients with ischaemic stroke.79–81 It could augment cerebral blood flow in the ipsilateral and contralateral hemispheres among patients with stroke with large artery occlusive disease, which may imply enhanced collateral flow to the ischaemic territories… A single session of ECP (1 hour) may be associated with transient improvement in the neurological symptoms of patients with stroke, according to the Counterpulsation to Upgrade Forward Flow in Stroke trial (23 patients).81 Another pilot study of 50 patients with ischaemic stroke with large artery occlusive disease showed a slightly more significant decrease in the NIHSS score (2.1 vs 1.3; p=0.061) after 35 daily sessions of ECP treatment (1 hour per session) than no ECP treatment.80 Therefore, ECP is a safe and possibly effective method to enhance cerebral blood flow and improve outcomes of patients with stroke, which warrants further investigation.”

In the Recommendation section of the publication the authors wrote “ ECP is safe and possibly effective to augment cerebral blood flow in patients with acute ischaemic stroke, while the clinical benefit needs further investigation (class IIb; level of evidence C).”